What to do when the bill is higher than the estimate

First, find the right two documents

You need the bill and the written Good Faith Estimate from the same provider or facility. Not a posted price you saw online, and not an estimate from a different office. If the visit involved more than one provider, for example an imaging center and a separate group that read the images, each one should have its own estimate and will send its own bill.

Match them up in pairs: this provider’s estimate with this provider’s bill.

Ask for an itemized bill

A summary bill with one total is hard to check. Call or write to the billing office and ask for an itemized bill that lists each service or item and its charge. You are asking for your own record, and it is a routine request.

When it arrives, go through it next to the estimate. Look for items that were not on the estimate, quantities that differ, and charges for something you did not receive.

Work out the difference per provider

For each provider or facility, subtract the estimate from the bill. Here is how that works with example data for one visit:

• Imaging center A: estimate $780, billed $1,240. That is $460 over.
• Radiology group: estimate $150, billed $190. That is $40 over.

The $400 line, and how it is counted

If the bill from any one provider or facility is at least $400 more than its Good Faith Estimate, you may be able to start the federal patient-provider dispute process (45 CFR 149.620). The $400 is counted per provider or facility, not in total across the visit.

In the example above, Imaging center A is $460 over its estimate, so it crosses the line. The radiology group is $40 over, so it does not, even though the visit as a whole is $500 over. Each bill stands on its own.

Watch the date on the bill

The dispute process has a time limit: you would need to start within 120 calendar days of the date on the bill. Calendar days, not business days. Write the date on the bill somewhere you will see it, and count forward so you know your last day.

Next steps, in order

If a bill is well above its estimate, these steps keep you organized:

• Ask the provider for an itemized bill.
• Compare each line to the written Good Faith Estimate.
• Call the billing office and ask about any line you do not understand. Note the date and what they said.
• If any one provider billed $400 or more over its estimate, you may be able to start the federal patient-provider dispute process within 120 calendar days of the date on the bill.
• Keep copies of the estimate, the bill, the itemized bill, and your notes.

Keep your copies

Whatever you decide, keep everything together: the estimate, the original bill, the itemized bill, any letters, and notes from each call with dates. If you pay part of the bill while you sort it out, keep the receipt too. A clear, dated paper trail makes every later conversation shorter.

BoDirect Plus includes a bill check that does the per-provider math and flags any bill that is $400 or more over its estimate. It explains your options in plain words. It does not file anything for you, and it does not contact the provider.